Chapter 14: Spinal Cord Injury Foundations

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OUTLINE

Objectives:

The student will appropriately:

1. Describe three principles used in the compensatory approach to rehabilitation in spinal cord injury (SCI).

2. Demonstrate understanding of these principles in the practice of various movements.

3. Practice common bed mobility and transfer strategies utilized in persons with tetraplegia.

4. Describe and demonstrate the four methods to go prone to/from prone on elbows utilized by persons with tetraplegia with no triceps function.

5. Describe and demonstrate the three methods to go supine to sitting utilized by persons with tetraplegia with no triceps function.

Introduction

The class discusses the three principles used in the compensatory approach to rehabilitation: muscle substitution, angular momentum, and the head-hips relationship.

Activity 1. Bed Mobility: Applying the Principles

Students perform mat activities (rolling, push up in sitting, scooting, and long sitting) with weights placed on their lower extremities if possible to simulate what it would be like for a person with tetraplegia.

Activity 2. Prone to/from Prone on Elbows

Students teach a partner the four methods to go prone to prone on elbows utilized by persons with tetraplegia with no triceps function.

Activity 3. Transfers: Supine to Sitting

Students teach a partner the three methods to go supine to sitting without using equipment utilized by persons with tetraplegia with no triceps function.

Activity 4. Wrap-Up Discussion

Students discuss strategies to maximize learning of compensatory motor skills by persons with SCI.

WORKSHEET

Introduction

Most individuals with spinal cord injury (SCI) must learn to use their bodies in an entirely different manner than before their injuries. Rehabilitation is aimed at helping the client to optimize neuroplasticity to recover as much function as possible and to use compensation where recovery is not possible. It is a delicate balance for both the client and the therapist to decide when and how much to incorporate both compensatory and neuroplastic principles of recovery.

A compensatory approach is one that trains the client to use the intact body structure and functions to compensate for those that have been lost or diminished. A recovery approach focuses on therapeutic techniques aimed at promoting recovery of functions so that the person can perform activities in the same way that they were done before the person was injured. Both approaches are crucial to optimal recovery. The primary method for the recovery approach is the use of body weight supported treadmill or overground training along with other seated and standing activities. These techniques are covered in the ambulation chapter of this textbook. For a more detailed description, ...